|
PR RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY
|
Professional
|
Both
|
$3,325.00
|
|
|
Service Code
|
HCPCS 58957
|
| Min. Negotiated Rate |
$404.15 |
| Max. Negotiated Rate |
$2,319.75 |
| Rate for Payer: Aetna Commercial |
$1,889.07
|
| Rate for Payer: Aetna Medicare |
$1,662.50
|
| Rate for Payer: BCBS Complete |
$1,330.00
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$2,319.75
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: Cash Price |
$2,660.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,161.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,714.90
|
| Rate for Payer: UHC Exchange |
$1,714.90
|
|
|
PR RESEC RECURRENT LARYNX NERVE
|
Professional
|
Both
|
$1,377.00
|
|
|
Service Code
|
HCPCS 31595
|
| Min. Negotiated Rate |
$550.80 |
| Max. Negotiated Rate |
$895.05 |
| Rate for Payer: Aetna Medicare |
$688.50
|
| Rate for Payer: BCBS Complete |
$550.80
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
|
|
PR RESECTION CONDYLE DISTAL END PHALANX EACH TOE
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 28153
|
| Min. Negotiated Rate |
$171.47 |
| Max. Negotiated Rate |
$988.45 |
| Rate for Payer: Aetna Commercial |
$347.52
|
| Rate for Payer: Aetna Medicare |
$327.00
|
| Rate for Payer: BCBS Complete |
$180.04
|
| Rate for Payer: BCBS Trust/PPO |
$988.45
|
| Rate for Payer: BCN Commercial |
$588.86
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Meridian Medicaid |
$180.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.59
|
| Rate for Payer: Priority Health Narrow Network |
$407.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.80
|
| Rate for Payer: UHC Exchange |
$305.80
|
| Rate for Payer: UHCCP Medicaid |
$171.47
|
|
|
PR RESECTION EXTERNAL CARDIAC TUMOR
|
Professional
|
Both
|
$4,644.00
|
|
|
Service Code
|
HCPCS 33130
|
| Min. Negotiated Rate |
$860.52 |
| Max. Negotiated Rate |
$3,018.60 |
| Rate for Payer: Aetna Commercial |
$1,832.84
|
| Rate for Payer: Aetna Medicare |
$2,322.00
|
| Rate for Payer: BCBS Complete |
$903.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.28
|
| Rate for Payer: BCN Commercial |
$1,958.62
|
| Rate for Payer: Cash Price |
$3,715.20
|
| Rate for Payer: Cash Price |
$3,715.20
|
| Rate for Payer: Meridian Medicaid |
$903.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,018.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,136.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,136.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,879.26
|
| Rate for Payer: UHC Exchange |
$1,879.26
|
| Rate for Payer: UHCCP Medicaid |
$860.52
|
|
|
PR RESECTION HUMERAL HEAD
|
Professional
|
Both
|
$1,645.00
|
|
|
Service Code
|
HCPCS 23195
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$1,156.63 |
| Rate for Payer: Aetna Commercial |
$996.87
|
| Rate for Payer: Aetna Medicare |
$822.50
|
| Rate for Payer: BCBS Complete |
$513.50
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$1,094.15
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Cash Price |
$1,316.00
|
| Rate for Payer: Meridian Medicaid |
$513.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,069.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,156.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$857.99
|
| Rate for Payer: UHC Exchange |
$857.99
|
| Rate for Payer: UHCCP Medicaid |
$489.05
|
|
|
PR RESECTION/INCISION SUBVALVULAR TISSUE
|
Professional
|
Both
|
$6,220.00
|
|
|
Service Code
|
HCPCS 33415
|
| Min. Negotiated Rate |
$642.41 |
| Max. Negotiated Rate |
$4,043.00 |
| Rate for Payer: Aetna Commercial |
$2,718.53
|
| Rate for Payer: Aetna Medicare |
$3,110.00
|
| Rate for Payer: BCBS Complete |
$1,338.32
|
| Rate for Payer: BCBS Trust/PPO |
$642.41
|
| Rate for Payer: BCN Commercial |
$2,902.25
|
| Rate for Payer: Cash Price |
$4,976.00
|
| Rate for Payer: Cash Price |
$4,976.00
|
| Rate for Payer: Meridian Medicaid |
$1,338.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,274.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,043.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,170.74
|
| Rate for Payer: Priority Health Narrow Network |
$3,170.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,647.95
|
| Rate for Payer: UHC Exchange |
$2,647.95
|
| Rate for Payer: UHCCP Medicaid |
$1,274.59
|
|
|
PR RESECTION MEDIASTINAL TUMOR
|
Professional
|
Both
|
$5,782.00
|
|
|
Service Code
|
HCPCS 39220
|
| Min. Negotiated Rate |
$723.14 |
| Max. Negotiated Rate |
$3,758.30 |
| Rate for Payer: Aetna Commercial |
$1,157.21
|
| Rate for Payer: Aetna Medicare |
$2,891.00
|
| Rate for Payer: BCBS Complete |
$759.30
|
| Rate for Payer: BCBS Trust/PPO |
$735.39
|
| Rate for Payer: BCN Commercial |
$1,639.03
|
| Rate for Payer: Cash Price |
$4,625.60
|
| Rate for Payer: Cash Price |
$4,625.60
|
| Rate for Payer: Meridian Medicaid |
$759.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$723.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,758.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,792.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,345.02
|
| Rate for Payer: UHC Exchange |
$1,345.02
|
| Rate for Payer: UHCCP Medicaid |
$723.14
|
|
|
PR RESECTION OF MEDIASTINAL CYST
|
Professional
|
Both
|
$5,041.00
|
|
|
Service Code
|
HCPCS 39200
|
| Min. Negotiated Rate |
$551.67 |
| Max. Negotiated Rate |
$3,276.65 |
| Rate for Payer: Aetna Commercial |
$891.30
|
| Rate for Payer: Aetna Medicare |
$2,520.50
|
| Rate for Payer: BCBS Complete |
$579.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.79
|
| Rate for Payer: BCN Commercial |
$1,253.95
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Cash Price |
$4,032.80
|
| Rate for Payer: Meridian Medicaid |
$579.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$551.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,276.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,372.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,372.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,042.37
|
| Rate for Payer: UHC Exchange |
$1,042.37
|
| Rate for Payer: UHCCP Medicaid |
$551.67
|
|
|
PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 28126
|
| Min. Negotiated Rate |
$162.52 |
| Max. Negotiated Rate |
$1,055.54 |
| Rate for Payer: Aetna Commercial |
$324.47
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: BCBS Complete |
$170.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.54
|
| Rate for Payer: BCN Commercial |
$566.87
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Meridian Medicaid |
$170.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.25
|
| Rate for Payer: Priority Health Narrow Network |
$387.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$291.80
|
| Rate for Payer: UHC Exchange |
$291.80
|
| Rate for Payer: UHCCP Medicaid |
$162.52
|
|
|
PR RESECTION PERICARDIAL CYST/TUMOR
|
Professional
|
Both
|
$2,869.00
|
|
|
Service Code
|
HCPCS 33050
|
| Min. Negotiated Rate |
$639.00 |
| Max. Negotiated Rate |
$1,864.85 |
| Rate for Payer: Aetna Commercial |
$1,346.58
|
| Rate for Payer: Aetna Medicare |
$1,434.50
|
| Rate for Payer: BCBS Complete |
$670.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.58
|
| Rate for Payer: BCN Commercial |
$1,448.93
|
| Rate for Payer: Cash Price |
$2,295.20
|
| Rate for Payer: Cash Price |
$2,295.20
|
| Rate for Payer: Meridian Medicaid |
$670.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$639.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,864.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,588.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,588.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,284.86
|
| Rate for Payer: UHC Exchange |
$1,284.86
|
| Rate for Payer: UHCCP Medicaid |
$639.00
|
|
|
PR RESECTION RIBS EXTRAPLEURAL ALL STAGES
|
Professional
|
Both
|
$3,144.00
|
|
|
Service Code
|
HCPCS 32900
|
| Min. Negotiated Rate |
$924.00 |
| Max. Negotiated Rate |
$2,061.73 |
| Rate for Payer: Aetna Commercial |
$1,838.39
|
| Rate for Payer: Aetna Medicare |
$1,572.00
|
| Rate for Payer: BCBS Complete |
$976.46
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: BCN Commercial |
$2,061.73
|
| Rate for Payer: Cash Price |
$2,515.20
|
| Rate for Payer: Cash Price |
$2,515.20
|
| Rate for Payer: Meridian Medicaid |
$976.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$929.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,043.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,866.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,866.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,620.18
|
| Rate for Payer: UHC Exchange |
$1,620.18
|
| Rate for Payer: UHCCP Medicaid |
$929.96
|
|
|
PR RESECTION SCROTUM
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 55150
|
| Min. Negotiated Rate |
$318.22 |
| Max. Negotiated Rate |
$2,291.77 |
| Rate for Payer: Aetna Commercial |
$631.01
|
| Rate for Payer: Aetna Medicare |
$793.00
|
| Rate for Payer: BCBS Complete |
$334.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,291.77
|
| Rate for Payer: BCN Commercial |
$715.42
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Meridian Medicaid |
$334.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$318.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$789.84
|
| Rate for Payer: Priority Health Narrow Network |
$789.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$584.99
|
| Rate for Payer: UHC Exchange |
$584.99
|
| Rate for Payer: UHCCP Medicaid |
$318.22
|
|
|
PR RESECTION/TRANSPLANTATION LONG TENDON BICEPS
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 23440
|
| Min. Negotiated Rate |
$134.57 |
| Max. Negotiated Rate |
$1,170.90 |
| Rate for Payer: Aetna Commercial |
$1,010.45
|
| Rate for Payer: Aetna Medicare |
$676.50
|
| Rate for Payer: BCBS Complete |
$517.76
|
| Rate for Payer: BCBS Trust/PPO |
$134.57
|
| Rate for Payer: BCN Commercial |
$1,112.72
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Meridian Medicaid |
$517.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$493.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,170.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,170.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$869.69
|
| Rate for Payer: UHC Exchange |
$869.69
|
| Rate for Payer: UHCCP Medicaid |
$493.10
|
|
|
PR RESPIRATORY FLOW VOLUME LOOP
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 94375
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$2,149.65 |
| Rate for Payer: Aetna Commercial |
$41.36
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,149.65
|
| Rate for Payer: BCN Commercial |
$55.71
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.00
|
| Rate for Payer: Priority Health Narrow Network |
$19.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.17
|
| Rate for Payer: UHC Exchange |
$38.17
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
|
|
PR RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 90378
|
| Min. Negotiated Rate |
$1,476.00 |
| Max. Negotiated Rate |
$2,398.50 |
| Rate for Payer: Aetna Commercial |
$1,857.07
|
| Rate for Payer: Aetna Medicare |
$1,845.00
|
| Rate for Payer: BCBS Complete |
$1,476.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.79
|
| Rate for Payer: BCN Commercial |
$1,700.79
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Cash Price |
$2,952.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,398.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,250.34
|
| Rate for Payer: UHC Exchange |
$2,250.34
|
|
|
PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 37222
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$1,131.09 |
| Rate for Payer: Aetna Commercial |
$249.11
|
| Rate for Payer: Aetna Medicare |
$298.00
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.09
|
| Rate for Payer: BCN Commercial |
$903.08
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.13
|
| Rate for Payer: Priority Health Narrow Network |
$286.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.28
|
| Rate for Payer: UHC Exchange |
$269.28
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
|
|
PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37220
|
| Min. Negotiated Rate |
$248.57 |
| Max. Negotiated Rate |
$3,691.47 |
| Rate for Payer: Aetna Commercial |
$538.63
|
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: BCBS Complete |
$261.00
|
| Rate for Payer: BCBS Trust/PPO |
$463.32
|
| Rate for Payer: BCN Commercial |
$3,691.47
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Meridian Medicaid |
$261.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.05
|
| Rate for Payer: Priority Health Narrow Network |
$619.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$592.91
|
| Rate for Payer: UHC Exchange |
$592.91
|
| Rate for Payer: UHCCP Medicaid |
$248.57
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT
|
Professional
|
Both
|
$4,999.00
|
|
|
Service Code
|
HCPCS 24371
|
| Min. Negotiated Rate |
$413.46 |
| Max. Negotiated Rate |
$3,249.35 |
| Rate for Payer: Aetna Commercial |
$2,368.46
|
| Rate for Payer: Aetna Medicare |
$2,499.50
|
| Rate for Payer: BCBS Complete |
$1,194.74
|
| Rate for Payer: BCBS Trust/PPO |
$413.46
|
| Rate for Payer: BCN Commercial |
$2,578.75
|
| Rate for Payer: Cash Price |
$3,999.20
|
| Rate for Payer: Cash Price |
$3,999.20
|
| Rate for Payer: Meridian Medicaid |
$1,194.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,137.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,249.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,700.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,700.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,310.88
|
| Rate for Payer: UHC Exchange |
$2,310.88
|
| Rate for Payer: UHCCP Medicaid |
$1,137.85
|
|
|
PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT
|
Professional
|
Both
|
$3,780.00
|
|
|
Service Code
|
HCPCS 24370
|
| Min. Negotiated Rate |
$355.73 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Aetna Commercial |
$2,055.18
|
| Rate for Payer: Aetna Medicare |
$1,890.00
|
| Rate for Payer: BCBS Complete |
$1,042.21
|
| Rate for Payer: BCBS Trust/PPO |
$355.73
|
| Rate for Payer: BCN Commercial |
$2,246.94
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Cash Price |
$3,024.00
|
| Rate for Payer: Meridian Medicaid |
$1,042.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$992.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,457.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,350.43
|
| Rate for Payer: Priority Health Narrow Network |
$2,350.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,004.91
|
| Rate for Payer: UHC Exchange |
$2,004.91
|
| Rate for Payer: UHCCP Medicaid |
$992.58
|
|
|
PR REVISION OF LARYNX, UNSPECIFIED
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 31588
|
| Min. Negotiated Rate |
$824.00 |
| Max. Negotiated Rate |
$1,339.00 |
| Rate for Payer: Aetna Medicare |
$1,030.00
|
| Rate for Payer: BCBS Complete |
$824.00
|
| Rate for Payer: Cash Price |
$1,648.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.00
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$522.92 |
| Max. Negotiated Rate |
$3,918.45 |
| Rate for Payer: Aetna Commercial |
$872.03
|
| Rate for Payer: Aetna Medicare |
$609.00
|
| Rate for Payer: BCBS Complete |
$549.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,918.45
|
| Rate for Payer: BCN Commercial |
$1,182.11
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Meridian Medicaid |
$549.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,097.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,097.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.42
|
| Rate for Payer: UHC Exchange |
$808.42
|
| Rate for Payer: UHCCP Medicaid |
$522.92
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$791.70 |
| Max. Negotiated Rate |
$9,903.88 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Medicare |
$6,389.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: ASR ASR |
$1,181.46
|
| Rate for Payer: ASR Commercial |
$1,181.46
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$997.42
|
| Rate for Payer: BCN Commercial |
$944.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,144.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Healthscope Commercial |
$1,218.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,389.60
|
| Rate for Payer: Mclaren Commercial |
$1,096.20
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.30
|
| Rate for Payer: Nomi Health Commercial |
$998.76
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Commercial |
$7,028.56
|
| Rate for Payer: PHP Medicaid |
$3,424.83
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,067.21
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$853.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$9,903.88
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP DNSP |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$791.70 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: ASR ASR |
$1,181.46
|
| Rate for Payer: ASR Commercial |
$1,181.46
|
| Rate for Payer: BCBS Trust/PPO |
$992.55
|
| Rate for Payer: BCN Commercial |
$944.32
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,144.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.40
|
| Rate for Payer: Healthscope Commercial |
$1,218.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,181.46
|
| Rate for Payer: Mclaren Commercial |
$1,096.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.30
|
| Rate for Payer: Nomi Health Commercial |
$998.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.84
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 19380
|
| Min. Negotiated Rate |
$522.92 |
| Max. Negotiated Rate |
$3,918.45 |
| Rate for Payer: Aetna Commercial |
$872.03
|
| Rate for Payer: Aetna Medicare |
$609.00
|
| Rate for Payer: BCBS Complete |
$549.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,918.45
|
| Rate for Payer: BCN Commercial |
$1,182.11
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Meridian Medicaid |
$549.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,097.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,097.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.42
|
| Rate for Payer: UHC Exchange |
$808.42
|
| Rate for Payer: UHCCP Medicaid |
$522.92
|
|
|
PR REVISION PERI-IMPLANT CAPSULE BREAST
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 19370
|
| Min. Negotiated Rate |
$435.59 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$723.37
|
| Rate for Payer: Aetna Medicare |
$622.00
|
| Rate for Payer: BCBS Complete |
$457.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$983.22
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Meridian Medicaid |
$457.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$435.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$914.32
|
| Rate for Payer: Priority Health Narrow Network |
$914.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$716.71
|
| Rate for Payer: UHC Exchange |
$716.71
|
| Rate for Payer: UHCCP Medicaid |
$435.59
|
|
